手动负压吸引人工流产术安全性的系统评价  

Safety of manual vacuum aspiration:A systematic review

作　　者：张文[1,2] 吴尚纯 

机构地区：[1]北京协和医学院研究生院,100730 [2]国家卫生计生委科学技术研究所

出　　处：《中国计划生育学杂志》2015年第5期292-298,309,共8页Chinese Journal of Family Planning

摘　　要：目的:系统评价手动负压吸引入工流产术(MVA)的安全性。方法:检索CBMdisc(1978-2014)、CNKI(1979-2014)、万方数据库(1982-2014)、维普数据库(1989-2014)、PubMed(1966-2014)、Cochrane Library(2014年第1期)及其他相关杂志,纳入MVA与电动负压吸引入流术(EVA)相比较的随机对照试验。评价纳入研究的方法学质量,采用RevMan5,0软件进行meta分析。结果纳入12篇文献,其中B级3篇,C级9篇。结果:术中出血量MVA组比EVA组更少[WMD及95%CI为-8.01(-8.86,-7.17)];在疼痛程度方面,以世界卫生组织四级疼痛分级为标准,则不同麻醉方法下MVA与EVA相比较,差异均无统计学意义[RR及95%CI分别为1.78(0.07,42.83),0.28(0.02,5.19)];在人工流产术前扩张宫颈时,MVA组的疼痛不受医生级别影响,而EVA组受术者感觉专科医生操作较住院医师引起的疼痛轻;手术时间两组差异无统计学意义[WMD及95%CI为-1.34(-2.83,0.15)];在人工流产综合反应(RAAS)发生率方面,MVA组比EVA组低[RR及95%CI为0.06(0.01,0.38)];不良反应发生MVA组与EVA组均较少,组间差异无统计学意义。结论:基于现有的最佳证据,MVA具有与EVA相似的安全性,且MVA具有更少的术中出血量、更低的RAAS发生率。Objective： To evaluate the safety of manual vacuum aspiration （MVA）. Methods： We searched medical databases including CBMdisc （1978-2014）, CNKI （1979-2014）, Wanfang Database （1982-2014）, VIP Database （1989- 2014）, PubMed （1966-2014）, Cochrane Library by computer and manually searched other related journals to screen randomized controlled trials （RCTs） that involved in the comparison of MVA and Electric vacuum aspiration （EVA）. The quality of included trials was assessed. RevMan5.0 software was used for meta-analysis. Results： Twelve trials were included, in which 3 RCTs were graded B and 9 were graded C. The blood loss of MVA was lower than that of e- lectric vacuum aspiration （EVA）, showing statistically significant difference [WMD （95% CI） value was -8.01 （-8.86,-7.17）]. There were no significant differences in pain perception degree between MVA and EVA in two subgroups with different anesthesia methods [RR （95% CI） values were 1.78 （0.07, 42.83）, 0.28 （0.02, 5.19）, respectively]. The pain perception of participants in MVA group when dilating cervix before the operation did not vary with the level of the doctor, while they felt less pain when operated by the faculty doctor than the resident doctor in the EVA group. There was no significant difference between MVA and EVA in terms of the operation time [WMD （95% CI） value was-1.34 （-2.83, 0.15）]. The incidence of artificial abortion syndrome of MVA was lower than that of EVA, showing a statistically significant difference [RR （95% CI） value was 0.06 （0.01, 0.38）]. The incidence of adverse reactions of MVA and EVA was low and there was no significant difference between two groups. Conclusion： Based on the current best evidence, MVA has the similar safety to EVA , and what is more MVA could reduce blood loss and the incidence of artificial abortion syndrome.

关 键 词：手动负压吸引人工流产术 电动负压吸引人工流产术 安全性 系统评价 

分 类 号：R169.42[医药卫生—公共卫生与预防医学]